The Changing Landscape of Forceps Delivery Over a Decade: Trends, Evolving Indications, and Maternal-Neonatal Outcomes in a Single Tertiary Center in China

For centuries, the birth of a human being has been a moment where medicine meets the raw, unpredictable force of nature. When a baby does not emerge on their own, doctors have long relied on two main tools to help: a vacuum cup that gently pulls the baby out, or a pair of specialized tongs called forceps that cradle the baby's head to guide them through the birth canal. These tools are not just mechanical aids; they represent a critical skill set that allows a doctor to intervene when labor stalls or when a baby shows signs of distress, potentially avoiding the need for major abdominal surgery. However, over the last few decades, the use of these tongs has become increasingly rare in many parts of the world. This decline has sparked a quiet worry among medical experts: as fewer doctors practice with forceps, the skill may be fading away entirely. If the skill is lost, the safety net it provides for mothers and babies could vanish, leaving only the choice between a difficult natural birth or a surgical one.

In a large hospital in China, a team of researchers decided to look closely at this changing landscape. They examined nearly 66,000 births that occurred over a twelve-year period, from 2014 to 2025, to see exactly what was happening to the use of forceps. Their goal was not just to count how many times the tools were used, but to understand why the numbers were changing and whether the babies and mothers were still safe when the tools were used. They wanted to know if the decline in forceps use was simply a matter of doctors choosing surgery more often, or if the reasons for using forceps had actually shifted. By comparing the outcomes of forceps deliveries against spontaneous births and against cases where a mother had already been fully dilated but still underwent a cesarean section, the researchers hoped to find out if the old tools were still safe and effective in the modern era.

The study revealed a clear and steady decline in the use of forceps. At the start of the period, about four and a half percent of births involved forceps, but by the end, that number had dropped to just under two percent. This drop happened at the same time that the rate of cesarean sections, or surgical births, was rising. The data showed a strong connection between the two: as the use of forceps went down, the use of surgery went up. It appeared that for many situations where forceps might have been used in the past, doctors were now opting for surgery instead. The researchers found that this shift was not random; it followed a specific pattern where the reasons for using forceps changed dramatically over the years.

In the early years of the study, the most common reason to use forceps was that the second stage of labor, the final pushing phase, had simply taken too long. Doctors would use the tools to help finish the job when a mother was exhausted. However, by the end of the study period, this reason had completely disappeared from their records. Instead, the reasons for using forceps had transformed. The tools were now being used almost exclusively for mothers who had complex health conditions or pregnancy complications. The researchers found that the use of forceps for difficult labor had been replaced by surgery, while the forceps were being reserved for specific, high-risk situations where their unique ability to maneuver a baby in a difficult position offered a clear advantage.

Despite this shift, the study offered reassuring news about safety. When the researchers compared the forceps group to mothers who gave birth naturally without assistance, they found that the forceps group did experience slightly more blood loss, which is expected when a medical procedure is performed. However, the health of the babies was very similar in both groups. The babies born with the help of forceps had nearly the same scores for their immediate health and breathing as those born without help. The most striking finding came when the researchers compared forceps deliveries to cesarean sections that were performed after the mother was already fully dilated. In these difficult cases, where a mother had pushed for a long time but still needed surgery, the amount of blood lost was almost identical whether the baby was delivered with forceps or with a scalpel. The rate of excessive bleeding was also statistically similar between the two groups once the mothers were matched for their specific health conditions.

The study also looked at who was most likely to need these tools. They found that first-time mothers were much more likely to require forceps than women who had given birth before. Older mothers and those carrying larger babies also faced a higher likelihood of needing assistance. The researchers noted that the few marks that sometimes appeared on a baby's face from the forceps were temporary and faded quickly, causing no long-term harm. The data suggested that when the tools are used for the right reasons by experienced hands, they remain a safe and viable option.

The overall picture that emerged from this twelve-year review is one of selective change rather than total abandonment. The practice of using forceps has not disappeared; it has evolved. The routine use of the tools for simple delays in labor has largely been replaced by surgery, but the skill remains vital for complex cases where it offers a distinct benefit. The researchers concluded that giving up the skill entirely would be a mistake. Instead, they suggest that the medical community should focus on preserving the ability to use forceps for those specific, high-value situations where it can make a real difference. By maintaining this expertise for the right patients, hospitals can ensure that they have a full range of options to keep both mothers and babies safe, rather than relying on a single path for every difficult birth.